THE ROLE AND FUNCTION OF EUROPEAN REGIONAL HEADQUARTERS IN JAPANESE MNCs

Multinational Corporations (MNCs) that establish Regional Headquarters (RHQ) expect the RHQs to become a management centre in the region. In this paper, the author focuses on three expected roles, that of a decision-maker, a coordinator, and as a transferor of knowledge on local operations and markets to the MNC. An interview survey examines the existence and roles of RHQs, defines minimal conditions for being defined as a RHQ, and determines seven such companies to be RHQs. All seven RHQs can be described as coordinators. Some RHQs coordinate their subsidiaries by controlling the flow of parts/products. Other RHQs assign their managers two titles or positions for coordinating subsidiaries. In other words, one manager has two functions: managing the region and a local company at the same time. From the point of the knowledge-based management, however, RHQs do not seem to work well. Though they are expected to transfer local knowledge to headquarters and other subsidiaries in MNCs, they often fail to systematically do so. To sum up, the author claims that the function and role of RHQs as knowledge based management centres needs to be bolstered.regional headquarters; Japanese MNCs; headquarters-like function; coordinator; knowledge flow

Effective treatment of a 13-year-old boy with steroid-dependent ocular myasthenia gravis using tacrolimus

Over the past several years, tacrolimus has attracted attention as a new therapeutic drug for myasthenia gravis (MG), but few reports have considered its use for MG in pediatric patients, and most of these have focused on severe systemic MG. In this case report, we used tacrolimus to successfully treat a 13-year-old boy with ocular MG who had suffered from severe steroid complications, including a failure of thrive and osteoporosis. He first showed symptoms of ocular MG at age 2 years 3 months. At age 13 years, he was receiving PSL (3.75 mg/day), but the symptoms of ocular MG recurred. We increased the dosage of oral PSL up to 30 mg/day, and three courses of mPSL pulse therapy were applied, but these therapies had only limited effect, and his symptoms worsened. Tacrolimus was started at 0.4mg/day (0.011mg/kg/day), and every two weeks the dose was gradually increased by 0.2mg/day. His symptoms of MG began to improve three weeks after the initial administration of tacrolimus. Approximately three months after the start of tacrolimus administration, PSL was discontinued. Currently, at one year and four months after the start of tacrolimus administration, while slight ptosis is observed in the evening, it does not influence his daily life, and his condition remains comparable to that when he stopped taking PSL. No adverse effects of tacrolimus have been recognized. In pediatric patients with steroid-dependent ocular MG without thymectomy, tacrolimus may be a safe and effective alternative to steroid and thymectomy

Usefulness of NIRS for medication adherence

The symptoms of attention deficit hyperactivity disorder (ADHD) are inattention, hyperactivity, and impulsiveness. Physicians often prescribe methylphenidate (MPH) for children with ADHD for long periods of time. The purpose of the present study was to investigate the usefulness of near-infrared spectroscopy (NIRS) for evaluating drug effects and improvements in medication adherence in children with ADHD. Subjects were 10 male children diagnosed with ADHD : average age, 9.3 years, and 10 boys with typical development : average age 9.5 years. Children with intellectual disability, autism, and obvious depressive symptoms were excluded. The present study revealed that in the ADHD group, oxy-Hb concentrations in the left and right lateral prefrontal cortex significantly increased during the execution of the Stroop color-word test in both channels when taking MPH. This method was considered to be useful for assessing drug effects on ADHD because NIRS is an objective indicator for evaluating ADHD executive dysfunction and visualizes the activation of frontal lobe function by MPH. A pediatric neurologist explained the results of NIRS while presenting images to the ADHD group, and medication adherence and the drug-taking ratio both markedly improved. Therefore, this therapeutic explanation is an effective strategy for improving medication compliance and adherence among patients

Neuroradiological and neurofunctional examinations for the patients with 22q11.2 deletion

Since neuroradiological features of patients with 22q11.2 deletion syndrome are not well-understood, examinations using functional imaging were performed in this study. Brain magnetic resonance imaging(MRI) and 1H-magnetic resonance spectroscopy(MRS) were performed using a clinical 3-tesla MR imager in 4 patients with 22q11.2 deletion syndrome (2 boys and 2 girls; 2~6 years.) and 20 age- and sex-matched healthy control subjects. Furthermore, interictal 123I- iomazenil (IMZ) single photon emission computed tomography(SPECT) was examined in two of the four patients. Among 4 patients with 22q11.2 deletion syndrome, 2 patients showed polymicrogyria and 1 patient showed agyria. Those patients with brain malformations also showed abnormal brain artery and decreased accumulation of IMZ in 123I-IMZ SPECT. Although all 4 patients showed epileptic discharges in electroencephalogram(EEG), one patient with polymicrogyria had no seizure episode. Decreases in γ-aminobutyric acid(GABA) corresponding to the areas of polymicrogyria and/or epileptic discharges in EEG were shown in all patients except for the patient with agyria. Although consistent evidence was not seen in patients with 22q11.2 deletion syndrome in this study, brain malformations and disturbances of the GABAergic nervous system would be underlying mechanisms of the neurodevelopmental abnormalities in this syndrome

Evaluation of the GABAergic nervous system in autistic brain : 123I-iomazenil SPECT study

Purpose: To evaluate the GABAA receptor in the autistic brain, we performed 123I-IMZ SPECT in patients with ASD. We compared 123I-IMZ SPECT abnormalities in patients who showed intellectual disturbance or focal epileptic discharge on EEG to those in patients without such findings. Subjects and methods: The subjects consisted of 24 patients with ASD (mean age, 7.3±3.5years), including 9 with autistic disorder (mean age, 7.0±3.7years) and 15 with Asperger’s disorder (mean age, 7.5±3.2years). We used 10 non-symptomatic partial epilepsy patients (mean age, 7.8±3.6years) without intellectual delay as a control group. For an objective evaluation of the 123I-IMZ SPECT results, we performed an SEE (Stereotactic Extraction Estimation) analysis to describe the decrease in accumulation in each brain lobule numerically. Results In the comparison of the ASD group and the control group, there was a dramatic decrease in the accumulation of 123I-IMZ in the superior and medial frontal cortex. In the group with intellectual impairment and focal epileptic discharge on EEG, the decrease in accumulation in the superior and medial frontal cortex was greater than that in the group without these findings. Conclusion The present results suggest that disturbance of the GABAergic nervous system may contribute to the pathophysiology and aggravation of ASD, since the accumulation of 123I-IMZ was decreased in the superior and medial frontal cortex, which is considered to be associated with inference of the thoughts, feelings, and intentions of others (Theory of Mind)

Age-related changes in a patient with Pelizaeus-Merzbacher disease by repeated 1H-MRS

Purpose: In this report, we describe a patient with Pelizaeus-Merzbacher disease (PMD) who underwent repeated evaluations by 1H-Magnetic resonance spectroscopy (MRS). Subject: The patient was given a definitive diagnosis of PMD based on genetic testing, which showed overlap of the proteolipid protein 1 (PLP1) gene. The control subjects for 1H-MRS consisted of healthy age-matched children. Methods: All measurements were performed with a clinical 3-tesla magnetic resonance imaging (MRI) system. For 1H-MRS, the center of a voxel was positioned in the right parietal lobe. 1H-MRS was performed when the patient was 2, 6, 14, and 25 months old. Results: The concentration of GABA in early childhood (2 months 1.72 mM, 6 months 2.15 mM) was increased compared with that in normal controls. However, his GABA concentration was normalized at 14 and 25 months. The concentrations of Ins were increased after 6 months. No remarkable changes were seen in the concentration of Cho at any time. Conclusion These results suggest that the changes in metabolite concentrations during growth may reflect the pathological state of PMD. Furthermore, the lack of a change in the Cho concentration may be useful for differentiating PMD from other demyelinating diseases

A 16q22.2-q23.1 deletion identified in a male infant with West syndrome

In partial monosomy of the distal part of chromosome 16q, abnormal facial features, intellectual disability (ID), and feeding dysfunction are often reported. However, seizures are not typical and the majority of them were seizure-free. Here we present the case of a 16q22.2-q23.1 interstitial deletion identified in a male patient with severe ID, facial anomalies including forehead protrusions and flat nose bridge, patent ductus arteriosus, bilateral vocal cord atresia treated by tracheotomy, and West syndrome, which were developed 10 months after birth. Although phenobarbital, sodium valproate (VPA), and zonisamide were not effective as monotherapies or combination therapies, the patient's epileptic seizures and electroencephalogram anomalies disappeared following combined therapy with lamotrigine and VPA. Although WW Domain Containing Oxidoreductase (WWOX), which is known as a cause of autosomal recessive epileptic encephalopathy, was included within the 6.8-Mb deleted region which identified by targeted panel sequencing and validated by chromosomal microarray analysis, no pathogenic variants were detected in the other allele of WWOX. Therefore, it is possible that other genes within or outside of the long deleted region or their interactions may cause West syndrome in this patient

Experimental demonstration of a hard-type oscillator using a resonant tunneling diode and its comparison with a soft-type oscillator

A hard-type oscillator is defined as an oscillator having stable fixed points within a stable limit cycle. For resonant tunneling diode (RTD) oscillators, using hard-type configuration has a significant advantage that it can suppress spurious oscillations in a bias line. We have fabricated hard-type oscillators using an InGaAs-based RTD, and demonstrated a proper operation. Furthermore, the oscillating properties have been compared with a soft-type oscillator having a same parameters. It has been demonstrated that the same level of the phase noise can be obtained with a much smaller power consumption of approximately 1/20

Multi-delay arterial spin labeling brain magnetic resonance imaging study for pediatric autism

Introduction Arterial spin labeling (ASL) is a non-invasive magnetic resonance imaging (MRI) technique that can measure regional cerebral blood flow (rCBF) without radiation exposure. This study aimed to evaluate rCBF in individuals with autism and their age-matched controls, globally and regionally. Methods We performed ASL MRI (3T, pulsed-continuous ASL, 3 delayed ASL imaging sequences) for 33 patients with autism spectrum disorder (ASD) (average age: 7.3 years, range: 2-14 years). Nineteen children (average age: 8.6 years, range: 3-15 years) without ASD and intellectual delay were included as controls. Patients with morphological abnormalities detected on MRI were excluded. Objective analysis was performed with automatic region of interest analysis of the ASL results. The Mann-Whitney U test was used to compare the rCBF results between the groups. Results Compared to the controls, patients with ASD showed a statistically significant decrease in rCBF, respectively, in the insula [left, rCBF 51.8±9.5 mL/100 g/min (mean±SD) versus 59.9±9.8, p=0.0017; right, 51.2±10.1 versus 57.8±8.8, p=0.0354], superior parietal lobule (left, 44.6±8.4 versus 52.0±7.8, p=0.003), superior temporal gyrus (left, 50.0±8.6 versus 56.9±8.6, p=0.007; right, 49.5±8.4 versus 56.4±7.7, p=0.0058), and inferior frontal gyrus (left, 53.0±9.8 versus 59.3±9.9, p=0.0279), which are associated with the mirror neuron system. Conclusions We concluded that patients with ASD showed a statistically significant decline in CBF in regions associated with the mirror neuron system. The advantages of ASL MRI include low invasiveness (no radiation exposure) and short imaging time (approximately 5 min). Studies with larger sample sizes are required to establish the diagnostic value of ASL MRI for ASD